Healthcare Provider Details

I. General information

NPI: 1619830601
Provider Name (Legal Business Name): KATE FOX VAN GROUW ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74-830 HWY 111 STE 100
INDIAN WELLS CA
92210
US

IV. Provider business mailing address

58363 BONANZA DR
YUCCA VALLEY CA
92284-6208
US

V. Phone/Fax

Practice location:
  • Phone: 760-568-2598
  • Fax:
Mailing address:
  • Phone: 760-568-2598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: